[Influence of Combination with 1q21 Amplification or-No in Patients with Newly Diagnosed MM on the Clinical Effecacy of Bortezomib-based induction chemotherapy and Long-Term Prognosis of Patients].

OBJECTIVE: To investigate the influence of influence of combination with 1q21 amplification or-no in patients with newly diagnosed MM on the clinical effecacy of bortezomib-based induction chemotherapy and long-term prognosis of patients. METHODS: 148 patients with newly diagnosed MM treated from January 2010 to May 2018 were selected and divided into 2 groups: group A (70 patients) without 1q21 amplification and group B (78 patients) with 1q21 amplification; and the survival benefit and influence on clinical efficacy of bortezomib were compared between 2 groups, and the factors influencing clinical prognosis in the patients with newly diagnosed MM were analyzed. RESULTS: The median PFS and OS of patients in B group were significantly shorter than those in group A (P＜0.05). There was no significant difference in the median OS and PFS between patients with 1q21 amplification copies number =3 and ＞3 (P＞0.05). Multivariate Cox model analysis indicated that the adverse factors for OS were ISS staging, Hb levels, ß2 microglobulin levels and 1q21 amplification respectively, and the adverse factors for PFS were Hb levels and 1q21 amplification respectively in patients with newly diagnosed MM (P＜0.05). The very good partial remission rate of newly diagnosed MM patients with 1q21 amplification and bortezomib-based induction chemotherapy were significantly higher than that in the patients without bortezomib-based induction chemotherapy (P＜0.05). The median PFS time of newly diagnosed MM patients with 1q21 amplification and auto-HSCT after bortezomib-based induction chemotherapy was significantly longer than that of patients without auto-HSCT (P＜0.05). CONCLUSION: 1q21 amplification should be the independent risk factor for poor prognosis of patients with newly treated MM. The application of bortezomib-containing induction chemotherapy in patients with 1q21 amplification can efficiently improve the remission rate, while auto-HSCT consolidation therapy may prolong patients' PFS.

[Biomechanical characteristics analysis on discs with coflex fixation on the different segments of lower lumbar spine].

OBJECTIVE: To investigate the biomechanical differences between the surgery and adjacent segments of intervertebral discs in the lower lumbar spine, which were implanted with Coflex into the segments of L4, and L5S1, respectively. METHODS: Three finite-element models (the model of the intact lower lumbar sacrum,the L4.5 and L5S1 segments implanted by Coflex) were developed, respectively. According to the spinal three-column loading theory, three models were forced by the physiological loads of upright standing, flexion and extension. The stress of the different areas of the disc annulus, the changes of intervertebral dorsal height and the degree of nucleus pulposus pressure were compared and analyzed. RESULTS: Coflex implanted into the L4.5 and L5S1 segments in compression and extension could both decrease the stress of the posterior area of intervertebral disc in the surgery segment, resist the changes of the intervertebral disc dorsal height and reduce the perssure of nucleus pulposus. Furthermore, the stress of the L5S1 segment decreased when Coflex fixed the L4.5 segment in extension. However, when Coflex fixed the L5S1 segment, the stress of L4.5 segment had no significant changes. CONCLUSION: Coflex fixing the L4,5 and L5S1 segments can effectively decrease the stress of the surgery segmental discs, respectively. Furthermore, Coflex fixing L4,5 segment may play a biomechanical role in reducing the stress of L5S1 segment.